Challenges with current definitions Options to address Media - Observation Challenges with current definitions Options to address

CURRENT STATE Observation Patient Media Binary identifier basedOn status category code subject context effective issued performer value dataAbsentReason interpretation comment bodySite method specimen device referenceRange related component identifier basedOn type subtype view subject context occurrence operator reasonCode bodySite device height width frames duration content note Identifier : photo contentType securityContext Content Attachment DT contentType language data url size hash title creation

Challenges & Needs Media and Observation look a lot alike. Unclear when to use Observation vs. Media. Should Observation include the image, photo, video, audio recording as well, or only address the observations about the picture, video, audio recording? Need to access image, photo, video, audio recording separate from the observations regarding them in systems such as Document Management System or Blob servers. Current structure one cannot make an Observation about a Media as the source. The attachment data type only contains the in-line data, cannot reference a Media instance with its metadata. The Attachment data type seems overloaded where it really seems to need to be a relationship to something else. Unclear what the role of DocumentReference is in all this as it looks like Media as well. Generally it seems the Observation, Patient, Media, Binary, and Attachment resources/data type need to be cleaned up one way or another to better related them to each other

Option Zero – Do Nothing If these challenges are not critical, keep it as-is But we think something needs to be addressed.

Option One The premise of Option One is that the observation includes the image, photo, video, audio as well as the observations about them. Therefore the primary change is to collapse Media into Observation for observation like data, and Option 1.A – create a new Media Data Type Option 2.A – update Attachment Data Type Open question whether either data type .data should actually point to Binary.

PROPOSED STATE – OPTION ONE - A Observation Patient Binary identifier basedOn status category code subject context effective (occurrence) issued performer Value dataAbsentReason interpretation comment (note) bodySite method (subtype) specimen device referenceRange related Component Ext:reasonCode Ext:view Identifier : Photo contentType securityContext Content Media DataType category (image/video/audio) contentType language data url size height width frames duration hash title creation

PROPOSED STATE – OPTION ONE - B Observation Patient Binary identifier basedOn status category code subject context effective (occurrence) issued performer Value dataAbsentReason interpretation comment (note) bodySite method (subtype) specimen device referenceRange related Component Ext:reasonCode Ext:view Identifier : Photo contentType securityContext Content Attachment DataType category (image/video/audio) contentType language data url size height width frames duration hash title creation Or is this in the end just an enhanced attachment?

Option One - Steps All at once. It seems difficult to do this in multiple steps.

Option Two The premise is that an image, photo, video, or audio recording is not an observation in itself, but rather that it is like the patient or specimen something separate about which observations can be made. That means that the Media resource stays, while changing: Observation.value not including valueAttachment Patient.photo having a choice of using Attachment data type of going to Media Consider that the Attachment data type goes to either Media (if metadata is needed) or Binary. Various other removals and adjustments The end-state would look like the next slide, but incremental steps could be taken to get there, identified after the next slide.

PROPOSED STATE – OPTION TWO Observation Patient Media Binary identifier basedOn status category code subject context effective issued performer value (valueAttachment) dataAbsentReason interpretation comment bodySite method specimen device referenceRange related (Ref: Media….) Component Identifier : Photo (Ref:Media) identifier type (photo/video/audio /docRef?) subtype subject context basedOn (Ref: Procedure, ProcedureRequest) view occurrence operator device reasonCode bodySite height width frames duration fileSize content data (Ref: Binary) note contentType securityContext content Attachment DataType contentType language data url content (Ref:Media) data or content, not both size hash title creation Same New Remove

Option Two - Steps Not all steps need to be take at once. We do not need to do all. Which ones are best done before Normative? Step One Replace Media.basedOn (Ref: ProcedureRequest) with Ref: Procedure) Change cardinality on Media.basedOn to 0..1 Step Two Remove valueAttachment from Obsevation.value Add Media to Observation.related Step Three Point Attachment.data to Binary and add Attachment.content with Reference to Media with constraint that Attachment can only have .data or .content, but not both. Step Four – STILL NEEDED WITH STEP THREE? Replace Photo Attachment Data Type with Reference to Media Step Five Remove .content from Media and replace with .data that points to Binary. Step Shrink Attachment Data Type by removing contentType, title, and creation Add Media.fileSize or Binary.fileSize Consider renaming Media.occurrence to acquisition or creation or whenAquired Remove Media.bodySite as it seems that once interesting, the Observation or the Media.basedOn Procedure would have this. Remove Media.view as it exist elsewhere, we think…

Document Reference vs. Media We don’t think there is value in collapsing DocumentReference and Media A Document typically represents a series observations/procedural/etc. data about other things, including media, and is organized based on the author and/or target audience’s needs. Media is the raw data about which observations can be made, but not an observation on its own. A Document seems to require substantially different metadata than Media, although they both can point to a Binary for the actual data. Therefore, would want to keep Media and DocumentReference separate and define boundaries better.

Questions Is Media.view already on other II resource? Can Attachment.data point to Binary? Should DocumentReference become a type of Media?